Wednesday, September 19, 2012

Although it would seem
obvious that children with ASD will eventually transition to adolescence and
adulthood, there is a paucity of information about effective interventions for
these age groups compared to data for younger children. Even though the core
symptoms of ASD (impairments in communication and social interaction and
restricted/repetitive behaviors and interests) may improve overtime with
intervention for many individuals, some degree of impairment typically remains
throughout the lifespan. Consequently,
the focus of intervention/treatment must shift from remediating core deficits in
childhood to promoting adaptive behaviors that can facilitate and enhance
ultimate functional independence and quality of life in adulthood. This
includes new developmental challenges such as independent living, vocational
engagement, post-secondary education, and family support. Unfortunately, there
is evidence to suggest that improvements in symptoms and problem behaviors may
decrease or end once youth with ASD transition from school-based programs. This
is likely due, at least in part, to the termination of services received
through the secondary school system upon exiting from high school, as well as
the lack of adult services. The lack of services available to help young adults
with ASD transition to greater independence has been noted by researchers for a
number of years and has become an increasingly important issue as the
prevalence of ASD continues to grow and as children identified with ASD reach
adolescence and adulthood.

Comparative Effectiveness
Review

What are the effects of
currently available interventions/treatments on adolescents and young adults
with ASD?To answer this question,
researchers at the Vanderbilt
Evidence-based Practice Center systematically reviewed evidence on therapies
for adolescents and young adults (ages 13 to 30) with autism spectrum disorders
(ASD). Their review focused on the outcomes, including harms and adverse
effects, of interventions addressing the core symptoms of ASD; common medical
and mental health comorbidities occurring with ASD; the attainment of goals
toward functional/adult independence; educational and occupational/vocational
attainment; quality of life; access to health and other services; and the
transitioning process (e.g., process of transitioning to greater independent
functioning). Researchers also addressed the effects of interventions on family
outcomes including parent distress and satisfaction with interventions.

Of more than 4,500 studies
on autism interventions published between 1980 and 2011, only 32 focused on interventions/therapies
for individuals ages 13 to 30. Most of the studies available were of poor
quality, which may reflect the relative recency of the field. Five studies,
primarily of medical interventions, had fair quality. Behavioral, educational,
and adaptive/life skills studies were typically small and short term and
suggested some potential improvements in social skills and functional behavior.
Small studies suggested that vocational programs may increase employment success
for some individuals. Few data are available to support the use of medical or
allied health interventions in the adolescent and young adult population. The
medical studies that have been conducted focused on the use of medications to
address specific challenging behaviors, including irritability and aggression,
for which effectiveness in this age group is largely unknown and inferred from
studies including mostly younger children. However, antipsychotic medications
and serotonin reuptake inhibitors were associated with improvements in specific
challenging behaviors. Similarly, little evidence supports the use of allied
health interventions including facilitated communication.

Conclusion

Despite an increasing
population of adolescents and young adults identified with an ASD and the need
for effective intervention across the lifespan, very few studies have been
conducted to assess treatment approaches for adolescents and young adults with
ASD. Moreover, the available research is lacking in scientific rigor. As a
result, there is little evidence available for specific treatment approaches in
this population; especially for evidence-based approaches to support the
transition of youth with ASD to adulthood. In particular, families have little
in the way of evidence-based approaches to support interventions capable of
optimizing the transition of teens with autism into adulthood. Research is
needed across all intervention types on which outcomes to use in future
studies. “Overall, there is very little evidence in all areas of care for
adolescents and young adults with autism, and it is urgent that more rigorous
studies be developed and conducted,” commented Melissa McPheeters, director of
Vanderbilt’s Evidence-Based Practice Center and senior author of the report. “There
are growing numbers of adolescents and adults with autism in need of
substantial support. Without a stronger evidence base, it is very hard to know
which interventions will yield the most meaningful outcomes for individuals
with autism and their families,” said Zachary Warren of Vanderbilt who also contributed
to the report.

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